Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
GBG Forschungs GmbH, Neu-Isenburg, Centre for Haematology and Oncology, Bethanien, Frankfurt, Germany.
Breast. 2024 Dec;78:103821. doi: 10.1016/j.breast.2024.103821. Epub 2024 Oct 11.
The incidence of breast cancer increases with age. Particularly in ageing societies, breast cancer has a significant impact on both the older patient and the healthcare system. In older patients with early breast cancer, there is a complex interplay between (i) tumor biology, (ii) risk of recurrence, (iii) comorbidities, (iv) frailty, (v) life expectancy and (vi) patient expectations and preferences. Our treatment guidelines are often based on large meta-analyses that have shown that (neo)adjuvant chemotherapy improves the survival rate in early breast cancer in general. This is particularly important in triple-negative and HER2-positive breast cancer, but hormone receptor (HR)-positive, HER2-negative patients with a higher risk of recurrence also benefit from chemotherapy. However, most studies included younger and carefully selected patients. Since there is a positive correlation between age and estrogen receptor status, as well as between age and the number of concomitant diseases and the tolerability of chemotherapy, it is of great importance to evaluate the effects of additional (neo)adjuvant chemotherapy, especially in older patients with early-stage breast cancer. There are only a few studies in which only older patients with early breast cancer were included. On the whole, they show that older patients with HR-positive, HER2-negative tumors hardly benefit from chemotherapy in addition to endocrine therapy. In these patients, additional chemotherapy should be considered critically when weighing up the potential benefits and harms. However, this critical evaluation should not be confused with abandoning standard chemotherapy when it is feasible and clinically indicated based on geriatric assessment, risk assessment, and patient preference. The aim of our narrative review is to provide a concise overview of the evidence on chemotherapy in older women with breast cancer and place it in the context of geriatric assessment and risk evaluation in older HR-positive, HER2-negative patients with early breast cancer. This in turn should help to critically weigh up the risks and benefits of chemotherapy for the individual older patient with early-stage breast cancer, which should ultimately lead to more individualized and at the same time more evidence-based treatment recommendations that take into account the complex interplay of different and sometimes contradictory patient- and tumor-specific factors.
乳腺癌的发病率随年龄增长而增加。特别是在老龄化社会中，乳腺癌对老年患者和医疗保健系统都有重大影响。在患有早期乳腺癌的老年患者中，（i）肿瘤生物学、（ii）复发风险、（iii）合并症、（iv）虚弱、（v）预期寿命和（vi）患者期望和偏好之间存在着复杂的相互作用。我们的治疗指南通常基于大型荟萃分析，这些分析表明（新）辅助化疗一般可提高早期乳腺癌的生存率。这在三阴性和 HER2 阳性乳腺癌中尤为重要，但激素受体（HR）阳性、HER2 阴性且复发风险较高的患者也从化疗中获益。然而，大多数研究纳入的是年轻且经过精心选择的患者。由于年龄与雌激素受体状态之间以及年龄与合并疾病数量和化疗耐受性之间呈正相关，因此评估额外（新）辅助化疗的效果非常重要，尤其是在早期乳腺癌的老年患者中。仅有少数研究仅纳入了早期乳腺癌的老年患者。总的来说，这些研究表明，HR 阳性、HER2 阴性肿瘤的老年患者除内分泌治疗外，几乎不能从化疗中获益。在这些患者中，在权衡潜在益处和危害时，应批判性地考虑额外化疗的应用。然而，这种批判性评估不应与基于老年评估、风险评估和患者偏好的可行性和临床指征下放弃标准化疗相混淆。我们的叙述性综述旨在提供关于老年乳腺癌女性化疗的证据的简明概述，并将其置于老年 HR 阳性、HER2 阴性早期乳腺癌患者的老年评估和风险评估背景下。这反过来应该有助于批判性地权衡化疗对早期乳腺癌老年患者个体的风险和益处，最终应导致更个体化且同时更基于证据的治疗建议，这些建议考虑到不同且有时相互矛盾的患者和肿瘤特异性因素的复杂相互作用。
